Archive for the ‘Health Insurance Reform’ Category

Today, the clouds parted and sanity returned.

I was driving and the news noted that a Republican House Member was introducing a bill that would move the 30 hour threshold for part-time people to get health coverage up to 40 hours. A rational move! From a member of the party opposed to anything that had “Obama” in the label.

If we are truly moving to repair, not replace, then we have turned a significant corner. We need to adjust this law, and make the bad parts better. And, remember, we need to have a law with flexibility. One size does not fit all.

Each of us has luggage, a beverage, and a smart phone...but we are different.

Each of us has luggage, a beverage, and a smart phone…but we are different.


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Hello, my name is Karl, and I love insurance. (group: Welcome, Karl)

I’m a self-described insurance geek, and I have been for years. My family has learned to not involve me in the planning of family events, as I enjoy predicting exactly what will go wrong during activities. I call it risk management, they call it irritating.

In the pie charts of projected ACA coverage, one slice really bothers me. I have always wondered who the people in the “Still No Insurance” slice are. What would push someone to NOT have insurance? I’m enough of an insurance geek and risk manager I just couldn’t fathom it. Fresh data came out on September 30, 2013 from Gallup: they surveyed more than 5000 uninsured Americans of various types, and asked whether they plan to get insurance or pay the fine for not doing so. 65 percent said they would get health insurance, 25 percent said they wouldn’t.

I wanted to find out who these risk scofflaws are that reject everything I hold dear. I didn’t have to look far – I found an example behind the counter at my local camera store. The head cashier has always been very cordial and efficient, an apparently intelligent person with a basic, professional mindset. Or so I thought.

I was wearing my dress shirt with “Gregory & Appel Insurance”. She overheard me talking with the owner about the opening of the Marketplaces and how it may affect their options. She pointed to the logo on my shirt and announced “I will never get health insurance, no matter what they say. I’m healthy, I don’t go to doctors and I certainly don’t need insurance. Not gonna do it.” Wow. That stopped me in my tracks.

Maybe I’m too close to it. Maybe I know too much. I spend hours each day keeping up with the flood of details involved in constructing the health insurance delivery systems. I work on crafting explanations for business, and communication materials to help the buying public understand the subject. I felt all of that crumbling as I faced an actual insurance denier.
I tried a question. “What if you get hit by a bus, and are injured for life. What then?” “My family will take care of me. We take care of our own. Besides, I’m very careful, and won’t get hit,” she said.

“What about auto insurance. Do you believe in that?” “No. I only have the minimum, and wouldn’t have that if I could get away with it. Just like my health, I never have accidents.” Her voice was rising in pitch.

“I sense you’re angry about all of this,” I noted. “Where does that anger come from?” “Why should those of us who are healthy and safe and good drivers help the ones who aren’t? Why should I help pay for the health claims of sick people, if I never get sick?” I asked if she might feel different if she was 50 and asthmatic, rather than 30 and no chronic conditions. “Ask me then. I don’t intend to be sick.”

“Okay, I get it. You’re independent. Do you consider yourself a part of a society that helps each other, or a nation of one?”
“Since I don’t want help, and I don’t need help, I guess I think all Americans should take care of themselves. We shouldn’t need to help each other. I think insurance is just a scam in general, as is welfare.”

Ah. A fiercely independent citizen who resents helping others. We’re seeing a lot of those these days, and it may explain a lot about the slice of the pie that will still be on the outside of the health insurance system in the future. I had one final thought, just to confirm my observations.
“So, am I correct that you would make a poor lifeguard? You wouldn’t want to get wet to save a drowning stranger?” She paused, thought, shrugged, and said “I Guess so. They should have learned to swim. Not my problem, that’s not a job I’d ever take.”

About one in six Americans is without health insurance. It will be interesting to see how that number trends as the marketplaces open and the ACA comes on line. I will be asking that clerk about her status and insurance outlook every time I visit, and will report back if any wisdom emerges over time.

I’m optimistic about most things, but…

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I wish you could have been there.  I was riding an airport shuttle on a recent business trip, and reluctantly started a conversation with the guy in the sport coat and trendy tie next to me.  I say reluctantly, as you never know how these conversations can go.

We traded answers on “What do you do?”  He: Policy Consultant for the US Government.  Me: Human Resources Consultant.

He perked up.  “Say, do you know much about Obama Care?”  I shrugged and offered I might.  “I’ve been working with a bunch of policy wonks in a think tank for 9 months, and none of them can explain the real purpose of the Affordable Care Act.  Frustrating.”

We were approaching the end of the bus ride.  As we stood up to get out, I turned to him and said: “It’s really quite simple.  The act intends to give existing insurance companies slightly more than 30 million new customers, many of whom are healthy.  For that, the insurance companies have to take everyone.  No exclusions, no carve outs, no lifetime caps.”  I stepped out of the bus.

He caught me at the next door.  “Is it really that simple?”

I kept walking and he kept up.  “Of course not.  But you asked what the purpose was, and that’s it – expanding coverage.  If you read the whole law – and I have – every sentence can be put in one of three categories.  Expanding coverage, improving quality of care, or finding ways to pay for it.”

He blinked and stopped.  He had an honest look of wonder on his face.  “Who ARE you?”  I shrugged.  “Just some guy…”

As I walked off, he said “You should get on television and tell that to the American People…”  I smiled and waved.  My good deed for the day.

My takeaway?  There needs to be more and better communication out there about these issues, done in ways that are tailored to each audience.   Experts like his policy wonks in the think tanks are too close.

When you’re inside the bottle, you can’t read the label.

Man on the street - explaining Obamacare, one citizen at a time...

Man on the street – explaining Obamacare, one citizen at a time…

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It is interesting to stand in the middle of free speech in action   – the perspective can be revealing. Last month,  I was on the front steps of the US Supreme Court as the Obamacare reform ruling  was revealed.  The scene was  a jumbled layer cake of professionalism and craziness.

The scene as the Court decided

As a benefits professional taking time off from a conference across the Potomac, I wanted to be there to experience the reaction firsthand to  share the experience with  my team back at Gregory & Appel.

The Media created a first layer no-nonsense “buffer zone” of cameras and lighting rigs. The second layer was a more of the random mix of supporters and opponents eagerly awaiting to see if their side won.

The third and final layer were more of the “protest junkies” who simply wanted a reason to yell a little bit, along with the outer layer of DC tourists with no other interest in the situation than just being interested citizens who wanted to get a photo of the chaos on this momentous day before rejoining their tour group in time for lunch.

It  was exciting to be at the center of the storm  of how our nation handles health insurance.

Yes, really. Belly dancers against the PPACA.

The crowd was either shouting to be heard or not listening at all, staring intently at smart phones tuned to SCOTUS blogs.  The first sign of the decision was a buzz of energy from the middle of the pack, with some screams of “Yes!  Yes!  Repealed!”  I learned later  that day that both FOX and CNN reported premature and incorrect alerts that the bill had been overturned as unconstitutional.

There are lessons in this moment.  If you want proof of the value of a responsible, methodical press, compare the actions of twitter, bloggers, etc to the print media.  CNN got it wrong – my wife Barbara got it right.  She texted me the correct news – taken from the NBC newscast back home in Indiana, and I was able to correct a knot of interns standing  next to me.

As the corrected news spread everywhere, the tone of the crowd shifted.  The “Pro” crowd smiled quietly  – perhaps  not fully believing the news. The buzz of the remaining viewers turned to strong disappointment, with someone finding a microphone  and shouting about the end of civilization.

Pete Williams figuring it all out – in 2 minutes.

I was  pushed back into the press  zone,standing on a riser watching the live reports begin.  A very polished CNBC anchor was reading a stapled, thick document and turned to his assistant and asked “What is Medicaid Severability, anyway?”   Up and down media row anchors intently read the thick ruling, hoping to find clarity in this complex ruling sometime before the end of the commercial break.

It was now time for me to go.  I found it ironic that the steps of the Supreme Court itself was the last place to learn how the Court ruled, but still the best place to be to see our Democracy in action.  From here, we move forward again advising our clients on the next and best steps they need to take in response to this ruling.

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We’re a few weeks away from a Supreme Court decision on the PPACA, and the policy wonks and news readers have gone pretty silent on the issue. A big part of the issue is that nobody has a clue on how the Supremes will decide, and nobody wants to feel dumb a week later.
Therefore, may I offer a simple tool that we can all understand?  Here is a “Bracketology” tool that can simply explain what will happen for each of the combinations of 6 variables.  Click here for the link to the tool.

They’ve decided weeks ago, but have not shared their wisdom yet…



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Wow.  Denmark is becoming the most progressive Food Nation.

On Saturday, the Danes (remember Hamlet?) introduced a “fat tax” on foods like butter and oil, with the goal of a healthier nation with higher life expectancy.  With the significant issues facing American health plans, we should watch how this succeeds or fails. 

The Nordic country introduced the tax Saturday, of 16 kroner ($3.00) per kilogram (2.2 pounds) of saturated fat in a product.  The tax is relatively small – a spokesman for Denmark’s Confederation of Industries says the tax will increase the price of a burger by around $0.15 and raise the price of a small package of butter by around $0.40.  It is probably the world’s first fat tax.

"But, look, the morn, in russet mantle clad, walks o'er the dew of yon high eastward hill." - William Shakespeare, Hamlet, 1.1

They are taking this step to fight off obesity.  Their obesity rate is less than 10%, which is below the European average of 15%.  We Americans are 33.8%.  Hoosiers are slightly larger than that.

I am reminded of the effort in a state legislature a few years back that would have made it illegal to sell any “high fat junk food” from a “quick service restaurant” to anyone with a Body Mass Index over 30 – the threshold for obesity.  It didn’t pass the full legislature and died in committee…

Full article here: http://tinyurl.com/43pt46w


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Now, it starts to get interesting.  As defined in the PPACA, the rules for building and running an insurance exchange are emerging.  The Feds (aka the Department of Health and Human Services)  have released the first major guidance document.  Want a peek under the hood?  Here is their web page… http://tinyurl.com/5uayxyq or click here if your link isn’t working.

There are 2 states with Exchanges up and running – Massachusets and Utah.  I’m going to do some research into the Utah experiment and report back…

The dawn of the Exchanges

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Just had a lunch of carrot sticks and hummus.  Good.  I’m motivated to get to a healthy weight and stay there, and it’s the season to make resolutions. 

My key motivator?  The impression I will leave with a certain 2 ½ year old.  My oldest grandbaby is halfway through his 2’s and on his way to 3, and I realized that he will have long-term memories through his life, starting about now.  My first memories were from about that time, and I realize that he is now gathering the first impressions that he will carry through life.

I want him to remember a healthy Grandpa.  I want him to have me as a health role model, not a cautionary tale.  Why?  Because I have been too heavy lately, and I see a lot of big people around me.  I want to be a good example to Christopher.  Also, if I’m doing a lot of work in organizational wellness, I need to walk the talk.  Pun intended – I wear a pedometer.

Also, I am angry that nearly 1 in 5 of our children ages 6 to 19 is obese. That’s up from approximately 1 in 20 in 1980. The hospital costs associated with childhood obesity are in the mega-millions.  That scares me, enough to change my own behavior.

And now, a brief rant.  The U.S. Department of Health and Human Services says “the causes of childhood obesity are multi-factorial.” No, they’re not. Our children are obese because they consume too much bad stuff and move too little. Their diets are high in bad carbohydrates (i.e., junk food) like french fries, sodas and sweets, and low in fresh vegetables, fruits and healthy sources of protein. They spend entirely too much time in front of televisions, video games and computers and not enough time in physical activity.

The best physical activity for a child is free play. A child enrolled in a micromanaged sport is not getting half the exercise I got playing sandlot games in the 1950s and ’60s. I recently did 2 hours in hand-to-hand care of Christopher in a park, and I liked what I saw.  He is certainly aerobic.

The solution?  Parents must  make their children’s weight a high priority. Yes, schools need to eliminate carbo-load lunches along with soda and snack machines, but in the final analysis, childhood obesity is going to be prevented and solved at home.   This is not tough.   Eat at least 90 percent of your meals at home, around the table instead of in front of a television set.  Prepare meals that are heart-healthy. When your children are hungry between meals, offer apples, cheese and raw vegetables. When they’re thirsty, direct them to the faucet.   Christopher’s mom is doing a fine job of this.

Exercise with them. Take daily walks and bicycle rides with your kids. Play catch. Throw Frisbees. When they say they’re bored, point to the back door.   

Okay, I’m off the soapbox for now.  But, learn from this.  Find out what you should weigh, get there and stay there. Having an overweight parent (and grandparent) greatly increases a child’s chances of being overweight.  As my friend Suzanne Metzger says – “The greatest gift you can give another is the example of your own life working, and working well.

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Welcome back!  Now, for the next drop in the bucket…

Rhetorical question – wouldn’t you love to have a quick guide to what is happening and when in health insurance reform?  I just found exactly that – click here.  It just takes some time and distance to make complex things clear…which is anther reason I am glad I work at Gregory & Appel.

Looking forward to a very interesting 2011.

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Just got news that a Federal District Court Judge( Henry E. Hudson, a George W. Bush appointee) has ruled the individual mandate in the PPACA unconstitutional.

So, why does this not matter?

He is the third district court judge to rule, and is the first to rule against the PPACA as enacted.  Ah, but here is the catch – He ruled against the government, but he didn’t stop the reform bill from going into force.  He refused to grant an injunction against the legislation’s continued implementation. The construction of the bill’s infrastructure will continue.

The plaintiffs in this case were asking that the entire bill be struck down, which the judge did not do.  He only ruled against the individual mandate, which is a helpful part of the bill but not the core operational issue.  I am not a legal type, even though I work in Insurance, but it appears clear that the language the judge chose to use sharply limits the scope of the court’s action.

The last word on all of this will be in the big marble building just East of the Capitol – the Supreme Court. The fact that the various courts are sniping at each other ensures that the Supreme Court will be the final decider.  As of now, if you are keeping score, the range of opinions is from “the law is fine” to “the individual mandate is not fine, but the rest of the law is.”   Who knows.  It may get partially repealed and Republicans may  block any attempts at a fix, but it’s a far cry from a world in which the Supreme Court strikes down the whole of the health-care law. 

Stay tuned – in about two years…

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